Management of Acute Renal Failure in Children

The pelvoureteric junction was repaired 4 weeks later allowing time for the inflammation due to the urine infection to settle.  The nephrostomy tube was left in place until the surgery.  The infection had caused a partial obstruction, which was of long-standing, to have become complete.  Once the infection had settled the kidney in fact drained (see the repeat nephrostogram).

A nephrostogram is not the usual way of confirming obstruction. This is more commonly assessed by a renogram study using an isotope, MAG3 which is injected intravenously and extracted by the proximal tubules which then secrete the MAG3 into the tubular lumen. The passage of isotope is followed using a gamma camera. A renogram following corrective surgery confirms good drainage of isotope on the right. (click here).

Important lessons are:

• Obstruction is a rare but treatable cause of acute renal failure.
• It is easily identified by ultrasound
• Once obstruction is relieved, it is important to keep up with a potentially high urine output.